Harm reduction at the crossroads and the rediscovery of drug user abstinence

Abstract

Harm reduction has been the single most influential idea impacting on the drugs field over the last 30 years. Recently, however, the ideas, policies and practices of harm reduction have been subjected to sustained criticism. In addition, harm reduction has fallen from political grace within the UK where drug policy has come to focus first and foremost on ensuring that drug treatment services are focused on enabling drug users to become drug free and the term harm reduction is not even mentioned within the current UK drug strategy. This article focuses on these challenges to harm reduction and considers the likely impact of a focus on abstinence within drug policy in the UK. It is suggested that harm reduction is at an important crossroads in its development where its supporters may need to either identify a way of working within a more abstinence focused drug treatment policy paradigm or risk increasing marginalization by advocating for drug law reform and drugs legalization. An alternative may be for harm reduction to focus more on influencing drug treatment services and policy development within developing countries.